Eye Surgery Scotland see and treat patients with a range of retinal conditions including:
Retinal tears or holes
Further information about treatments can also be found below:
What is the retina?
The retina is the very thin layer of cells that is attached to the inner lining of the eye. It can be thought of as the ’film‘ in a pre-digital cameras that takes a picture which is then sent via the optic nerve to the brain to be interpreted.
Since the eyeball is curved, the retina is a curved structure allowing us to see from all directions. Your peripheral or ’side vision‘ relies on the outer parts of the retina, while your central vision relies upon the centre of the retina (the macula). More specifically, within the centre of the macula is another well-defined but tiny area which is responsible for fine detail, for reading, seeing colours, driving, recognising faces etc.
What is the vitreous?
This is normally a clear ’jelly’ which fills the inside cavity of the eye. The vitreous is vital during a baby’s development inside the womb as it forms many parts of the eye. During childhood, the vitreous is thick and very difficult to remove but as we grow older, the jelly becomes more watery and becomes much easier to remove.
The vitreous is firmly attached to all parts of the retina and this is the underlying reason for a number of conditions that can seriously affect sight. Many of these conditions require surgical intervention and removal of the vitreous, which is why certain eye specialists are referred to as Vitreo-Retinal Surgeons.
Retinal Tears or Holes
There are many types of retinal tears. Those occurring acutely resemble the shape of a horseshoe and are also referred to as ‘U’ tears. These tears are at higher risk of developing into a retinal detachment and can be treated with either laser or cryotherapy.
Laser treatment surrounds the tear and acts like ‘spot welding’, preventing the tear from developing into a retinal detachment.
Cryotherapy freezes and seals the area around the tear, preventing retinal detachment.
In addition, ‘round holes’ can be present in the retina – approximately 5% of the population exhibit these holes. This type of retinal hole rarely leads to retinal detachment and current thinking is not to treat these holes.
Very rarely, round holes lead to retinal detachment and because the vitreous is not affected, patients may be totally unaware of any symptoms. However, changes can develop over many years which may eventually lead to a problem affecting the central vision.
Retinal detachment is when the retina peels away from the inside of the eye, which can cause loss of vision.
Most retinal detachments are caused by a break or hole in the retina and although they occur spontaneously, they can be the result of a sudden change in the vitreous. Some retinal detachments develop slowly but almost all start from the periphery, leading to loss of side vision. If a retinal detachment progresses to the macula, your central vision can be severely affected.
Some patients complain of seeing flashing lights although seeing ‘floaters’ in front of you is a more reliable symptom of a retinal tear.
Once a break in the retina has formed, as vitreous is now watery, it can leak through the break and cause the retina to peel off and become ‘detached‘. This invariably affects the outer retina (which is responsible for side vision) so sometimes goes unnoticed.
Progression of a retinal detachment depends upon many factors and can be slow or very rapid and can lead to sudden loss of central or total vision in the affected eye.
The separation of the vitreous from the retina is called a posterior vitreous detachment. The vast majority of patients experiencing acute onset of floaters will not develop a retinal tear or retinal detachment and even those who have had floaters for years are very unlikely to be have anything worrying which requires a consultation with Eye Surgeons.
What should I do if I’m worried about retinal detachment?
If you experience any of the symptoms mentioned, please contact an optometrist or your GP urgently – or contact Edinburgh Eye Surgeons. Depending on availability, it may be possible to be seen urgently by one of the Edinburgh Eye Surgeons.
All Edinburgh Eye Surgeon surgical repairs for retinal detachment are currently carried out at The Eye Pavilion in Edinburgh.
Are there any possible complications with retinal surgery?
The commonest problem is the development of cataract, which is clouding of the eye’s natural lens. This usually occurs 6-24 months after vitrectomy operations and if this happens, the cataract can be dealt with and an artificial lens can be inserted.
Other less common but serious complications include an eye infection called Endophthalmitis. This is extremely rare but any reduction in vision associated with pain in the eye requires urgent attention and patients need to seek advice straight away. Endophthalmitis can be treated but may lead to loss of vision.
A retinal detachment can occur after vitrectomy which is also rare and could be resolved by further surgery. Another potential problem during vitrectomy is a haemorrhage under the retina. This can also lead to loss of vision but, fortunately, is also a very rare event.
Although many retinal conditions can be successfully treated, recurrence of the underlying condition can happen although vitrectomy surgery can easily be repeated.
We still do not know how the vast majority of macular holes develop but they are more common in women.
Macular holes affect the very centre of the macula and causes the retinal edges to separate. The structural integrity and function of the macula is severely affected, leading to decreased and often distorted central vision. Macular holes are initially small and usually lead to less severe vision loss but they can enlarge into larger holes, which can cause severe loss of central vision.
It is best to treat smaller macular holes early as this can result in a significant improvement in vision. Large holes can be closed with surgery but there is less visual improvement.
Surgery includes performing a vitrectomy at the same time as removing the membrane around the macular hole, followed by inserting a gas bubble. Surgery can be performed under local or general anaesthetic and after surgery, patients may be advised to keep their head in a downward position for five days.
Over 90% of macular holes can be successfully treated with one procedure.
This condition is synonymous with pre-macular fibrosis, cellophane maculopathy and macula pucker.
With epiretinal membranes, a membrane grows on the surface of the macula, leading to central visual problems which are often described as ’distorted vision‘.
Approximately 75% of patients with epi-retinal will notice an improvement in vision following surgical treatment. This treatment involves a vitrectomy combined with peeling off the membrane from the surface of the retina, which is carried out either under local or general anaesthesia.
Although the commonest reason for a vitreous haemorrhage is complications of diabetic retinopathy, there are other conditions that can lead to this happening.
One condition requiring urgent attention is when a retinal tear forms due to vitreous detachment, causing blood to spill into the eye. In this case, patients may be aware of flashing lights followed by sudden loss of vision. This requires urgent assessment as a vitreous haemorrhage can quickly lead to retinal detachment.
Vitreous haemorrhages due to retinal tears are often treated with urgent vitrectomy surgery, which is usually successful.